Provider Demographics
NPI:1801243290
Name:LAM, SHIRLEY (HIS)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:331-229-8208
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:460 SAINT MICHAELS DR
Practice Address - Street 2:STE 901
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7619
Practice Address - Country:US
Practice Address - Phone:505-820-6500
Practice Address - Fax:505-820-0339
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM871237700000X
TX80617237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist